Childcare practices in relation to nutritional status of children aged 6-36 months in Mwembesongo and Mjimpy a wards - Morogoro, Tanzania
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A comparative cross sectional study was carried out in Morogoro Municipality, Tanzania from July to September 2002. The purpose of the study was to establish whether the longterm implementation of the Child Survival Protection and Development Programme has more impact than that of a short term. The objective was to compare childcare practices performed by caregivers to nutritional status of children aged 6-36 months in Mwembesongo and Mjimpya wards, with nine and one year of program implementation respectively. The study was based on two hypotheses, that 'there is no significant difference in childcare practices and nutritional status of children aged 6-36 months old in Mwembesongo and Mjimpya wards' and that 'there is no relationship between childcare practices and nutritional status in the study areas' . The two study areas, Mwembesongo and Mjimpya wards were randomly selected from the 19 wards of Morogoro Municipality. Ten streets from each ward were also randomly selected. A sample of 164 mother/child pairs, each representing a household from each ward was randomly selected. From each ward a sub-sample of 33 households was randomly selected to provide data on food intake using the 24-hour recall method. A structured questionnaire was used to collect quantitative data on socio-demographic, economic and maternal characteristics, as well as feeding, hygiene, health and psychosocial care practices. Anthropometric measurements, height and weight were collected and used for generating indices of nutritional status. Data entry, cleaning and analysis were done using the Statistical Package for Social Sciences (SPSS version 10.0) and Epi Info (version 6.0) packages. The findings show that the children from Mwembesongo were exclusively breastfed for a significantly longer period (50 days) than those in Mjimpya ward (32 days) and that significantly more mothers (95.7%) in Mwembesongo than in Mjimpya (84.5%) took their children for growth monitoring. More households in Mwembesongo (56.7%) boil drinking water as compared to Mj impya (41.2%). The Majority of mothers in Mj impya (71.5%) as compared to Mwembesongo (51.8%) breastfed immediately (less than one hour) after birth. The following childcare practices were similar, provision of pre lacteal foods, breastfeeding duration (of more than two years), antenatal care attendance of mothers, and child immunisation status. The study revealed that there was no significant difference in child's nutritional status (wasting and underweight) between the two wards, except in stunting. More children in Mwembesongo (39.7%) than Mjimpya (27.5%) were stunted. The study used both anthropometric indices (Z scores) and indicators to investigate the association between childcare practices and nutritional status putting into context the length that the Child Survival Development and Protection has been in existence. Most of the childcare attributes are associated with nutritional status in the two wards. Breastfeeding initiation and duration, the amount of cash spent for child's food and fully fathers' financial support is associated with WAZ and HAZ scores in both wards. From these results, there is not enough evidence to support the hypothesis that there is no relationship between childcare practices and nutritional status. The study found no significant relationship between child's nutrition status and sex. The findings of the study led to the following conclusions. Although the study examined 13 difTerent childcare practices, only four, that is, the initiation of breastfeeding, duration of exclusive breastfeeding, the practice of boiling water for drinking, and utilization of growth monitoring programme, showed significant difference between the study groups. This is considered to be a reflection of the implication of the length of the time the programme has been in existence on childcare practices. The performance of Mwembesongo group was better than that of Mjimpya group except in the initiation of breastfeeding. The findings therefore, lead to partial rejection of the hypothesis that there is no significant difference in childcare practices between the two wards and to the conclusion that some of the beneficial effects of childcare practices require longer period to be entrenched in household systems. Six of the 13 childcare practices and related factors that were examined were significantly associated with nutritional status of the children in hoth study groups. However, three additional practices in Mwembesongo (making a total of nine) and one Mjimpya (making a total of seven) were also associated with the nutritional status. These findings affirm that childcare practices have an impact on nutritional status of children. Further studies are recommended to establish the threshold period after which the programme stops to have an impact or the impact becomes sustainable. The finding that there was no difference between the long and short-term project experience implies and supports the idea of project monitoring and strategic project reviews.